A Simple Chart to Communicate Health-behaviors-associated Mortality
Background Unhealthy behaviors are trending towards the increase. This study aimed to develop a risk chart for personalized risk communication, which can induce a positive health behavioral change. Methods 2235 middle-aged men were followed-up for a median time of 28 years. Participants were assessed for their smoking status, quality of diet expressed in Healthy Nordic Diet (HND) index, and alcohol drinking. After controlling for age, Body Mass Index (BMI), physical activity, and comorbidities,
... the variables' association with all-cause mortality was analyzed. Results Smoking, quality of diet, and alcohol drinking were associated to mortality risk with hazard ratios (HRs) of 2.72 [95% confidence interval (CI) 2.22–3.33], 0.88 (95% CI 0.82–0.94), and 1.13 (95% CI 1.10–1.17) respectively. Based on the analysis model [area under the curve (AUC) 72.8, 95% CI 70.8–74.9], a risk chart was presented allowing risk comparison across different predictors and for different combinations of health behaviors. A dysergic BMI-smoking interaction was found, suggesting that the individual effects of smoking and high BMI on mortality were lower when they co-existed. The combined effects of obesity (BMI > 30), smoking, poor quality diet (HND 1), and high level of alcohol consumption (475 g/week) associated with nearly 10 folds the mortality risk of a normal weight individual engaged in healthy behavior regardless of age, and a loss of 20 years in median survival. Conclusion The risk chart can be used as a tool to offer personalized risk communication and improve individuals' perception of the risk associated to their health behaviors.